Insights

Posted on Wednesday, September 21, 2016 1:14 AM

CMS lacks in providing education for agencies about maintenance therapy. However, CMS must have a plan in place by October 3 that will address this topic.

A U.S. District Court judge in Burlington, Vt., ordered the federal government last month to obey with a settlement agreement approved in January 2013 as part of the Jimmo v. Sebelius case.

The Court explained that the plaintiffs had “bargained for the accurate provision of information regarding the maintenance coverage standard and their rights under the Settlement Agreement would be meaningless without it.”

“The two sides will hash it out and try to come up with a solution that we all agree on,” says Gill Deford, an attorney with the Center for Medicare Advocacy in Willimantic, Conn.

According to Deford, “there’s no timeline for how long follow-up discussions about education might take or when CMS will actually provide the education.”

The Center for Medicare Advocacy eventually expects the request for additional education to include “a sustained, ongoing effort to provide education rather than a one-and-done tone that came out of the first educational campaign,” states Ali Bers, an attorney with the Center for Medicare Advocacy.

“Agencies have historically received denials for lack of improvement, and even though consultants have worked to explain that maintenance therapy is permitted, it feels as though agencies still want guidance with CMS’ logo on it,” says Krafft.

The recent motion was filed because CMS agreed in a federal court settlement three that “failure to improve” isn’t a valid reason to deny home care to Medicare beneficiaries. (HHL 3/14/16).

The judge’s August 17 decision felt that “at least some” information provided by in the educational campaign “was inaccurate, nonresponsive, and failed to reflect the maintenance coverage standard.”

As a result of the settlement, CMS made several changes to the Medicare Benefit Policy Manual. There were a “couple of provisions that we didn’t feel were sufficient and were still causing confusion” — but the judge found CMS’ efforts did not violate the settlement agreement, Bers says.

For the full article, please see the September 19, 2016 Home Health Line Edition.